Endovascular and hybrid treatment of thoracic and thoracoabdominal aortic aneurysms and dissections

Bondarenko P.B.¹, Shlomin V.V.², Shloido E.A.², Puzdryak P.D.², Gordeev M.L.¹, Gusinskiy A.V.¹, Fionik O.V.¹

1) Department of Cardiovascular Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health,
2) Department of Vascular Surgery, Municipal Multimodality Hospital № 2, Saint Petersburg, Russia

The article deals with immediate and medium-term results of hybrid and endovascular treatment of 74 patients with various pathologies of the thoracic and thoracoabdominal aorta (31 with aneurysms, 43 with thoracic and thoracoabdominal aortic dissections). Elective and emergency interventions were performed in 49 and 25 patients, respectively. Endoprosthetic repair of the arch, descending thoracic and thoracoabdominal aorta was performed in 25 patients, hybrid operations in 47 subjects (open switch of brachiocephalic, visceral and renal arteries followed by aortic endoprosthetic repair – 37, endovascular methods of making a landing zone – 12). The duration of the follow-up period after discharge from hospital amounted to 24.9±16.3 months. The technical success level was 98.6%. The overall hospital mortality rate was 11% (n=8), elective – 4% (n=2), emergency – 24% (n=6). Eight patients underwent repeat interventions on the thoracic and thoracoabdominal aorta. The 5-year cumulative survival rate was 82.3%, with freedom from repeat interventions amounting to 51.3%.

Hybrid operations on the arch and descending thoracic aorta are considered to be a relatively safe and effective method of treatment. Follow-up and timely treatment of remote complications after hybrid or endovascular operations are obligatory for improving the results.

KEY WORDS: thoracic aortic aneurysm, thoracoabdominal aneurysm, aortic dissection, thoracic artery endoprosthetic repair, hybrid aortic surgery, complications after endoprosthetic repair.

P. 59

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